A scoring tool to identify East African HIV-1 serodiscordant partnerships with a high likelihood of pregnancy

Renee Heffron, Craig R. Cohen, Kenneth Ngure, Elizabeth Bukusi, Edwin Were, James Kiarie, Nelly Mugo, Connie Celum, Jared M. Baeten, Deborah Donnell, Robert W. Coombs, Lisa Frenkel, Craig W. Hendrix, Jairam Lingappa, M. Juliana McElrath, Kenneth Fife, Elioda Tumwesigye, Patrick Ndase, Elly Katabira, Allan RonaldJonathan Wangisi, James Campbell, Jordan Tappero, Carey Farquhar, Grace John-Stewart, Anna Wald, Mary Campbell, Lawrence Corey, James P. Hughes, Amalia Magaret, Rhoda Morrow, James I. Mullins, David Coetzee, Max Essex, Joseph Makhema, Susan Allen, Kayitesi Kayitenkore, Etienne Karita, William Kanweka, Bellington Vwalika, Saidi Kapiga, Rachel Manongi, Mubiana Inambao, Sinead Delany-Moretlwe, Helen Rees, Guy De Bruyn, Glenda Gray, James McIntyre, Ruanne Barnabas, Harald Haugen, Lara Kidoguchi, Susan Morrison, Jennifer Morton, Andrew Mujugira, Caitlin Scoville, Bettina Shell-Duncan, Kathy Thomas, Steven Asiimwe, Edna Tindimwebwa, Nulu Bulya, Josephine Odoyo, David Bangsberg, Jessica Haberer, Norma Ware, Monique Wyatt, Mark Marzinke.

Research output: Contribution to journalArticle

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Abstract

Introduction: HIV-1 prevention programs targeting HIV-1 serodiscordant couples need to identify couples that are likely to become pregnant to facilitate discussions about methods to minimize HIV-1 risk during pregnancy attempts (i.e. safer conception) or effective contraception when pregnancy is unintended. A clinical prediction tool could be used to identify HIV-1 serodiscordant couples with a high likelihood of pregnancy within one year. Methods: Using standardized clinical prediction methods, we developed and validated a tool to identify heterosexual East African HIV-1 serodiscordant couples with an increased likelihood of becoming pregnant in the next year. Datasets were from three prospectively followed cohorts, including nearly 7,000 couples from Kenya and Uganda participating in HIV-1 prevention trials and delivery projects. Results: The final score encompassed the age of the woman, woman's number of children living, partnership duration, having had condomless sex in the past month, and non-use of an effective contraceptive. The area under the curve (AUC) for the probability of the score to correctly predict pregnancy was 0.74 (95% CI 0.72-0.76). Scores ≥7 predicted a pregnancy incidence of >17% per year and captured 78% of the pregnancies. Internal and external validation confirmed the predictive ability of the score. Discussion: A pregnancy likelihood score encompassing basic demographic, clinical and behavioral factors defined African HIV-1 serodiscordant couples with high one-year pregnancy incidence rates. This tool could be used to engage African HIV-1 serodiscordant couples in counseling discussions about fertility intentions in order to offer services for safer conception or contraception that align with their reproductive goals.

Original languageEnglish (US)
Article numbere0145515
JournalPloS one
Volume10
Issue number12
DOIs
StatePublished - Dec 1 2015

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ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Heffron, R., Cohen, C. R., Ngure, K., Bukusi, E., Were, E., Kiarie, J., Mugo, N., Celum, C., Baeten, J. M., Donnell, D., Coombs, R. W., Frenkel, L., Hendrix, C. W., Lingappa, J., McElrath, M. J., Fife, K., Tumwesigye, E., Ndase, P., Katabira, E., ... Marzinke., M. (2015). A scoring tool to identify East African HIV-1 serodiscordant partnerships with a high likelihood of pregnancy. PloS one, 10(12), [e0145515]. https://doi.org/10.1371/journal.pone.0145515